Knee prosthesis including rotatable spine

ABSTRACT

A knee joint prosthesis is disclosed. The knee joint prosthesis can include a tibial baseplate, a tibial insert, and a spine. The tibial baseplate can include a tibial plateau, having a proximal surface and an opposing distal surface, and a tibial stem extending from the distal surface of the tibial plateau. The tibial insert can be located on the proximal surface of the tibial plateau and can include an aperture. The spine can extend through the aperture of the tibial insert and into a cavity of the tibial stem, from the proximal surface of the tibial plateau. The spine can be rotatable with respect to the tibial baseplate and the tibial insert. The knee joint prosthesis can further include a femoral component including a posteriorly-located femoral cam. The posteriorly-located femoral cam can engage the spine during movement of the knee joint prosthesis.

CLAIM OF PRIORITY

This application is a continuation of U.S. patent application Ser. No.14/189,205, filed on Feb. 25, 2014, which claims the benefit of U.S.Provisional Patent Application Ser. No. 61/783,279, filed on Mar. 14,2013, the benefit of priority of each of which is claimed hereby, andeach of which are incorporated by reference herein in its entirety

TECHNICAL FIELD

The present disclosure relates to orthopedic prostheses and,specifically, to knee prostheses.

BACKGROUND

Orthopedic prostheses are commonly utilized to repair or replace damagedbone and tissue in a human body. A knee prosthesis, for example, caninclude a tibial component or a femoral component to replace damaged ordestroyed bone in the tibia or femur, respectively. Knee prostheses canseek to provide articulation similar to an anatomical articulation of anatural knee joint.

Total knee replacement (TKR) surgery can involve the implantation ofseveral components meant to restore the functionality provided by anatural knee. Typical TKR components include a tibial component, afemoral component, and/or an insert or bearing component disposedbetween the tibial and femoral components.

In certain TKR prostheses, which are oftentimes referred to as“posterior stabilized” prostheses, a cam positioned in an intercondylarfossa of a femoral component cooperates with a spine formed in a tibialcomponent to guide or constrain motion within predefined boundaries.Posterior stabilized prostheses can include a spine integrally formedwith a tibial bearing insert (sometimes referred to as a meniscalcomponent), which interacts with a cam formed in a femoral component topromote femoral roll back during flexion of the TKR prosthesis.Posterior stabilized prostheses can be appropriate where a posteriorcruciate ligament (PCL) is torn or otherwise damaged, or where the PCLis resected during surgery.

In addition, some knee prostheses feature a hyperextension stop, whichcan be a posterior-facing structure formed in a femoral componentconfigured to engage an anterior-facing surface of the tibial spine whenthe knee prosthesis is in a “full extension” or “hyperextension”orientation. Such a hyperextension stop can also be referred to as ananterior cam. In these knee prostheses, interaction between the femoralcomponent and spine operates as a physical stop against extension of theknee prosthesis past a predetermined level of extension.

A natural knee experiences internal and external rotation, i.e.,rotation about a generally proximal-distal axis, during flexion.Internal/external rotation can be significant in deep flexion where anasymmetric anteroposterior rollback can occur, i.e., the lateral femoralcondyle rolls back faster and/or further than the medial condyle.Internal/external rotation is also significant as the natural kneeapproaches extension (i.e., 0-20 degrees), a phenomenon sometimesreferred to as the “screw-home” mechanism. Knee prosthesis designs canseek to accommodate, promote or drive internal/external rotationmimicking the natural knee.

OVERVIEW

The present disclosure provides a knee joint prosthesis including aspine, which rotates when contacted by a posterior femoral cam. Thespine can accommodate internal/external rotation of prosthesiscomponents, while maintaining a large cam/spine surface area contact.The knee joint prosthesis can include a tibial baseplate component and atibial insert, with the spine seated in a cavity of a stem of the tibialbaseplate and extending proximally through an aperture formed in thetibial insert.

A distal portion of the spine, i.e., the portion of the spine extendingthrough the tibial bearing and baseplate and into the cavity of thestem, can each feature a taper angle. This taper angle can be controlledto balance competing interests of free rotation and vertical stability.Free rotation, or the ability of the spine to rotate in response to arelatively small force exerted by the posterior femoral cam, can bepromoted by a large taper angle (i.e., a more conical spine). Verticalstability, or the resistance of the spine to lifting out of its seat inresponse to a relatively large force exerted by the posterior femoralcam, can be promoted by a smaller taper angle.

To further illustrate the knee prosthesis systems disclosed herein, anon-limiting list of examples is provided here:

In Example 1, a knee joint prosthesis can comprise a tibial baseplate, atibial insert, and a spine. The tibial baseplate can include a tibialplateau, having a proximal surface and an opposing distal surface, and atibial stem extending from the distal surface of the tibial plateau. Thetibial insert can be located on the proximal surface of the tibialplateau and can include an aperture. The spine can extend through theaperture of the tibial insert and into a cavity of the tibial stem, fromthe proximal surface of the tibial plateau. The spine can be rotatablewith respect to the tibial baseplate and the tibial insert.

In Example 2, the knee joint prosthesis of Example 1 can optionally beconfigured such that the spine includes a proximal spine portion,projecting proximally from a proximal articular surface of the tibialinsert, having at least one cam surface configured to articulate with aposterior femoral cam.

In Example 3, the knee joint prosthesis of any one or any combination ofExamples 1 or 2 can optionally be configured such that the spineincludes an intermediate spine portion, disposed within the aperture ofthe tibial insert, configured to rotatably articulate with a wall of theaperture.

In Example 4, the knee joint prosthesis of Example 3 can optionally beconfigured such that the intermediate spine portion has a shapecomprising one of cylindrical, slightly tapered, or fully tapered.

In Example 5, the knee joint prosthesis of any one or any combination ofExamples 1-4 can optionally be configured such that the spine includes adistal spine portion, disposed within the cavity of the tibial stem,having a tapered, substantially conical shape.

In Example 6, the knee joint prosthesis of any one or any combination ofExamples 3-5 can optionally be configured such that at least one of theintermediate spine portion and the distal spine portion includes asleeve coupled about an outer spine surface.

In Example 7, the knee joint prosthesis of any one or any combination ofExamples 1-6 can optionally be configured such that the tibial insertincludes a sleeve coupled to a surface of the aperture.

In Example 8, the knee joint prosthesis of any one or any combination ofExamples 1-7 can optionally be configured such that the tibial stemincludes a sleeve coupled to a surface of the cavity.

In Example 9, the knee joint prosthesis of any one or any combination ofExamples 1-8 can optionally be configured such that the tibial insert ismobile relative to the tibial baseplate.

In Example 10, the knee joint prosthesis of any one or any combinationof Examples 1-8 can optionally be configured such that the tibial insertis fixed relative to the tibial baseplate.

In Example 11, a knee joint prosthesis can comprise a femoral componentincluding a lateral condyle, a medial condyle, and an intercondylarfossa disposed between the lateral and medial condyles. The femoralcomponent further comprises an articular surface including respectivesurfaces of the lateral and medial condyles; a bone-contacting surface,opposite the articular surface, configured to affix the femoralcomponent to a distal portion of a femur; an anterior cam, disposedanteriorly of the intercondylar fossa, extending from thebone-contacting surface; and a posterior cam disposed posteriorly of theanterior cam.

In Example 12, the knee joint prosthesis of Example 11 can optionally beconfigured such that the posterior cam is configured to engage a tibialspine during movement of a knee joint.

In Example 13, the knee joint prosthesis of Example 11 can optionally beconfigured such that the anterior cam is configured to engage a tibialspine during movement of a knee joint.

In Example 14, a knee joint prosthesis can comprise a tibial baseplate,a tibial insert, a spine, and a femoral component. The tibial baseplatecan include a tibial plateau, having a proximal surface and an opposingdistal surface, and a tibial stem extending from the distal surface ofthe tibial plateau. The tibial insert can be located on the proximalsurface of the tibial plateau and can include an aperture and a proximalarticular surface. The spine, rotatable with respect to the tibialbaseplate and the tibial insert, can extend through the aperture of thetibial insert and into a portion of the tibial stem. The femoralcomponent, engageable with the tibial insert, can include an articularsurface, configured to abut the proximal articular surface of the tibialinsert, and a posterior cam, configured to engage the spine.

In Example 15, the knee joint prosthesis of Example 14 can optionally beconfigured such that the spine includes a proximal spine portion,projecting proximally from the proximal articular surface of the tibialinsert, having at least one cam surface configured to articulate withthe posterior cam.

In Example 16, the knee joint prosthesis of any one or any combinationof Examples 14 or 15 can optionally be configured such that the spineincludes an intermediate spine portion, disposed within the aperture ofthe tibial insert, configured to rotatably articulate with a wall of theaperture.

In Example 17, the knee joint prosthesis of Example 16 can optionally beconfigured such that the intermediate spine portion has a shapecomprising one of cylindrical, slightly tapered, or fully tapered.

In Example 18, the knee joint prosthesis of any one or any combinationof Examples 14-17 can optionally be configured such that the spineincludes a distal spine portion, disposed within the tibial stem, havinga tapered, substantially conical shape.

In Example 19, the knee joint prosthesis of any one or any combinationof Examples 16-18 can optionally be configured such that at least one ofthe intermediate spine portion and the distal spine portion includes asleeve coupled about an outer spine surface.

In Example 20, the knee joint prosthesis of any one or any combinationof Examples 14-19 can optionally be configured such that the tibialinsert includes a sleeve coupled to a surface of the aperture.

In Example 21, the knee joint prosthesis of any one or any combinationof Examples 14-20 can optionally be configured such that the tibial stemincludes a sleeve coupled to a surface of the cavity.

In Example 22, the knee joint prosthesis of any one or any combinationof Examples 14-21 can optionally be configured such that the tibialinsert is mobile relative to the tibial baseplate.

In Example 23, the knee joint prosthesis of any one or any combinationof Examples 14-21 can optionally be configured such that the tibialinsert is fixed relative to the tibial baseplate.

In Example 24, the knee joint prosthesis of any one or any combinationof Examples 14-23 can optionally be configured such that the femoralcomponent further includes an anterior cam disposed anteriorly of theposterior cam.

In Example 25, the knee joint prosthesis of Example 24 can optionally beconfigured such that the anterior cam is configured to engage the spineduring movement of a knee joint.

In Example 26, the knee joint prosthesis of any one or any combinationof Examples 14-25 can optionally be configured such that the posteriorcam is configured to engage the spine during movement of a knee joint.

In Example 27, the knee joint prosthesis (or related methods) of any oneor any combination of Examples 1-26 can optionally be configured suchthat all elements recited are available to use or select from.

These and other examples and features of the present knee prosthesiswill be set forth in part in the following Detailed Description. ThisOverview is intended to provide non-limiting examples of the presentsubject matter—it is not intended to provide an exclusive or exhaustiveexplanation. The Detailed Description below is included to providefurther information about the present knee prosthesis.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a perspective, exploded view of a knee joint prosthesis inaccordance with the present disclosure.

FIG. 1B is a plan view of a tibial spine of the knee joint prosthesisshown in FIG. 1A.

FIG. 2A is a front, cross-sectional view of a fixed-bearing kneeprosthesis in accordance with the present disclosure, illustrating anon-tapered intermediate spine portion.

FIG. 2B is a side, cross-sectional view of the fixed-bearing kneeprosthesis of FIG. 2A.

FIG. 3A is a front, cross-sectional view of a fixed-bearing kneeprosthesis in accordance with the present disclosure, illustrating apartially-tapered intermediate spine portion.

FIG. 3B is a side, elevation view of the fixed-bearing knee prosthesisof FIG. 3A.

FIG. 4A is a front, cross-sectional view of a fixed-bearing kneeprosthesis in accordance with the present disclosure, illustrating afully-tapered intermediate spine portion.

FIG. 4B is a side, cross-sectional view of the fixed-bearing kneeprosthesis of FIG. 4A.

FIG. 5A is a front, cross-sectional view of a mobile-bearing kneeprosthesis in accordance with the present disclosure.

FIG. 5B is a side, elevation view of the mobile-bearing knee prosthesisof FIG. 5A.

FIG. 6 is an elevation, cross-section view of a knee joint prosthesis inaccordance with the present disclosure, shown in an extensionorientation before a flexion motion is initiated.

FIG. 7 is an elevation, section view of the knee joint prosthesis shownin FIG. 6, shown in a partial flexion orientation during a flexionmotion.

FIG. 8 is an elevation, partial section view of the knee jointprosthesis shown in FIG. 6, shown in a high flexion orientation during aflexion motion.

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplifications set out hereinillustrate examples of the invention, and such exemplifications are notto be construed as limiting the scope of the invention in any manner.

In the drawings, which are not necessarily drawn to scale, like numeralscan describe similar components in different views. Like numerals havingdifferent letter suffixes can represent different instances of similarcomponents. The drawings illustrate generally, by way of example, butnot by way of limitation, various examples described in the presentdocument.

DETAILED DESCRIPTION

The present disclosure provides an orthopedic knee joint prosthesisincluding a spine that rotates to maintain a large-area contact with aposterior femoral cam during internal/external rotation. The rotatablespine can define a generally elongate structure extending through atibial bearing and a tibial baseplate, and into a cavity formed in astem extending distally from the baseplate, such that the spine rotatesfreely about its longitudinal axis. When the spine is contacted by theposterior femoral cam (such as in medium-to-deep flexion or in fullextension), the interaction therebetween can act to automatically rotatethe spine to a configuration of greatest conformity between thecontacting faces. This configuration can maximize the contact areabetween the cam and spine, even as internal/external rotation occurs inthe knee joint prosthesis.

Advantageously, the large cam/spine surface area contact minimizes wear,by maintaining low contact pressure(s) between the cam and spine. Evenwhere substantial internal or external rotations occur, such as in deepflexion or full extension, rotation of the cam can drive concurrentrotation of the spine. These rotations can ensure a maximum area ofcam/spine contact for any given level of knee flexion by ensuring the“flat” or large-radius posterior and anterior faces of the spine arepresented to the corresponding surface of the posterior femoral cam orhyperextension stop (e.g., an anterior cam of a femoral component).Similarly, interaction between the posterior femoral cam and the“corners” or smaller-radius portions of the spine can be prevented.

In order to prepare a tibia and a femur for receipt of a knee jointprosthesis of the present disclosure, any suitable methods orapparatuses for preparation of the tibia and femur can be used. In thefollowing description, “proximal” refers to a direction toward the torsoof a patient, while “distal” refers to the opposite direction ofproximal, i.e., away from the torso of the patient. “Anterior” refers toa direction toward the front of a patient, while “posterior” refers tothe opposite direction of anterior, i.e., toward the back of thepatient. While the examples described herein are described with regardto a right knee, it will be appreciated that the present disclosure isequally applicable to a left knee configuration.

FIG. 1A illustrates a knee joint prosthesis 10 including a femoralcomponent 12, a tibial baseplate 14, a tibial insert 16, and a spine 18.The femoral component 12 and the tibial baseplate 14 can be configuredto mount to a distal femur and a proximal tibia, respectively. Thetibial insert 16 can rest atop a proximal surface 42 of the tibialbaseplate 14 and can be disposed between the femoral component 12 andthe tibial baseplate 14. The spine 18 can be coupled to the tibialbaseplate 14 and can extend proximally through an aperture 60 of thetibial insert 16, such that a portion of the spine 18 extends out of thetibial insert 16 to engage with the femoral component 12, as furtherdescribed below.

The spine 18, the tibial baseplate 14, and the tibial insert 16 can bemanufactured from a wide range of materials including metals, plastics,polymers, polyethylene, polyurethanes, polyether ether ketone (PEEK),carbon fibers, composite materials, and combinations thereof. The spine18 can include two or more layers of materials and can either beun-sleeved, fully sleeved, or partially sleeved. Similarly, the aperture60 of the tibial insert 16 can either be un-sleeved, fully sleeved, orpartially sleeved, and a cavity 48 in the baseplate 14 can either beun-sleeved, fully sleeved, or partially sleeved. The selection ofmaterials and possible sleeving of one or all of the spine 18, theaperture 60, or the cavity 48 can provide greater wear resistance andminimize friction between the moving parts.

An articular surface 22 of the femoral component 12 can articulate witha proximal articular surface 56 of the tibial insert 16. In the exampleof FIG. 1A, a proximal surface 42 of tibial baseplate 14 can rotatablyarticulate with a distal surface 62 of the tibial insert 16, such thatknee joint prosthesis 10 can be a mobile bearing design. As noted below,however, other examples can be a fixed-bearing design, in which thetibial insert 16 is fixed relative to the tibial baseplate 14.

The spine 18 can be a separate component that is received within a stem38 of the tibial baseplate 14, either prior to surgical implantation ofthe knee prosthesis 10 or intraoperatively. The spine 18 can berotatably coupled to the tibial baseplate 14, such that the spine 18 canbe rotatable about its longitudinal axis during articulation of kneejoint prosthesis 10. As described in detail below, the spine 18 canrotate during articulation of the prosthesis 10 to ensure a desiredcontact configuration between a posterior femoral cam 36 of the femoralcomponent 12 and a posterior cam surface 54 (see FIG. 1B) of the spine18.

As shown in FIG. 1A, the femoral component 12 can include a bonecontacting surface 20 and an articular surface 22, each extendingbetween an anterior flange 24 and a posterior side 26. The bonecontacting surface 20 can be configured to affix the femoral component12 to a distal portion of a femur, such as with bone cement and/orporous bone-ingrowth material. The femoral component 12 can include amedial condyle 28 and a lateral condyle 30, with an intercondylar fossa32 formed between the condyles 28, 30. The articular surface 22 can bedisposed generally opposite the bone contacting surface 20, and can becomprised of the exterior surfaces of the medial and lateral condyles28, 30 as well as the exterior surface of the anterior flange 24 of thefemoral component 12. The femoral component 12 can include the posteriorfemoral cam 36 formed at the posterior side 26. The posterior femoralcam 36 can span the medial and lateral condyles 28, 30, and can occupythe intercondylar fossa 32. FIG. 6 illustrates an example of anassembled knee joint prosthesis 10 in an elevation, cross-section view,shown in an extension orientation. The spine 18 is shown occupying theintercondylar fossa 32 of the femoral component 12. The posteriorfemoral cam 36 is shown in this example as not contacting the spine 18in an extension of the knee, but, in another example, can be configuredto contact the spine 18 at this point of knee articulation.

Returning to FIG. 1A, the spine 18 can include distal spine portion 46,which can be sized to be received within a correspondingly sized cavity48 formed in tibial baseplate 14. In one example of the presentdisclosure, the distal spine portion 46 can have a generally conicalshape. The spine 18 can further include a proximal spine portion 50having an anterior surface 52 and a posterior cam surface 54 (see FIG.1B). As further described below, the anterior surface 52 can be shapedand configured to provide clearance for a patella in deep flexion of theknee, and can additionally act as a hyperextension stop by cooperatingwith the femoral component 12 to prevent the knee prosthesis 10 fromextending significantly past a full extension configuration. Theposterior cam surface 54 can be shaped and configured to cooperate withthe posterior femoral cam 36 to guide rollback and allow rotation of theknee joint prosthesis 10 along a specific motion profile during flexion.

As noted above, the spine 18 of the knee prosthesis 10 can be rotatablewith respect to the tibial baseplate 14 and the tibial insert 16. Thespine 18 can extend through the tibial plateau 40 and into the tibialstem 38. The distal portion 46 of the spine 18 can extend into acorrespondingly shaped cavity 48 formed in the stem 38. In use, theproximal portion 50 of the spine 18 can be the primary point of appliedforces during articulation of the prosthesis 10, as the posteriorfemoral cam 36 of the femoral component 12 impacts and presses againstthe cam surface 54 (see FIG. 1B) of the spine 18. This applied force canbe counteracted by interaction between the stem 38 of the tibialbaseplate 14 and the distal portion 46 of the spine 18, as furtherdescribed below.

In an example, the distal portion 46 of the spine 18 can extend throughsubstantially all of the longitudinal extent of the stem 38, while stillproviding a sealed distal end to prevent ingress of unwanted debris atthe interface of the spine 18 and an inside wall of the cavity 48. Thestem 38 can be tapered as in the illustrative example of the figures,and the distal portion 46 of the spine 18 can also be tapered tomaximize the thickness of the spine 18 for a given wall thickness in thetibial stem 38.

As a result of the spine 18 extending deeply into the cavity 48, thespine 18 can advantageously provide a long moment arm and large surfacearea that can combine to distribute the forces exerted on the proximalportion 50 of the spine 18 (i.e., by the posterior femoral cam 36 duringknee articulation) over a large surface area of the inside wall of thecavity 48. This wide distribution of forces acts to minimize pressureand friction between the distal portion 46 of the spine 18 and theinside wall of the cavity 48. This minimized friction, in turn, promoteslow wear and long service life for the spine 18. Fluid can also enterthe space between the cavity 48 and the spine 18 and this can alsofurther improve tribiologics (e.g. reduced friction and wear).

Referring now to FIGS. 2A and 2B, a fixed-bearing knee prosthesis 110can include a tibial baseplate 114, a tibial insert 116, and a spine118. The knee prosthesis 110 can be similar to the prosthesis 10described above, with reference numerals of prosthesis 110 having thesame numerals used as the prosthesis 10 except with 100 added thereto.Structures of the prosthesis 110 correspond to similar structuresdenoted by corresponding reference numerals of the prosthesis 10, exceptas otherwise noted.

Unlike the prosthesis 10 described above, the prosthesis 110 is afixed-bearing design, which is to say the tibial insert 116 is fixedwith respect to the tibial baseplate 114 rather than beingrotatable/mobile. The spine 118 remains mobile, however, in that thespine 118 is rotatable with respect to the tibial baseplate 114 and thetibial insert 116. To facilitate spine rotation, the spine 118 passesthrough an aperture 160 of the tibial insert 116 with clearance on allsides.

The tibial baseplate 114 can include substantially vertical walls 199extending proximally from a floor 198 of the tibial baseplate 114, whichcan act to secure the tibial insert 116 and keep the tibial insert 116from moving during articulation of the knee. Although illustrated inthis manner, the tibial insert 116 can be stabilized to a tibialbaseplate 114 that does not have vertical walls 199. The tibial insert116 can be fixed to the tibial baseplate 114 by gluing, cementing,fastening, clamping, interference fit, or any other practical means.Maintaining mobility (i.e., rotational freedom) of the spines 18, 118can allow posterior cam surfaces 54, 154 (FIGS. 1B and 2B, respectively)to automatically maximize the contact area between the cam surfaces 54,154 and the posterior femoral cam 36 (FIG. 1A) of the femoral component12, in either a fixed- or mobile-bearing design. More particularly, asthe posterior femoral cam 36 contacts the cam surface 154 of the spine118 in deep flexion, the spines 18, 118 can rotate freely to seek thelowest-pressure configuration, which is the rotational spine orientationhaving the largest possible contact area.

Referring again to FIGS. 1A and 1B, using the spine 18 for illustration,this largest contact area can be achieved by the posterior femoral cam36 contacting the relatively flat or large-radius posterior cam surface54, as opposed to the smaller radius “corners” 55 bounding the medialand lateral edges of the cam surface 54. If the posterior femoral cam 36does contact one of the corners 55, the spine 18 can be urged to rotateinto a lower pressure configuration. Given that the spine 18 can rotatefreely under this urging force, the spine 18 can continue to rotateuntil the lowest-pressure configuration is achieved, which can be theconfiguration in which the posterior femoral cam 36 creates a large-areacontact with the posterior cam surface 54. In seeking thislowest-pressure configuration, the spine 18 can be said to“automatically” rotate under the pressure from the posterior femoral cam36, and can therefore automatically adjust to accommodate internal andexternal rotation of the femur relative to the tibia.

Referring now to FIGS. 2A and 2B, an anterior cam 34 (see FIG. 6) formedin the femoral component 12 can impact the anterior surface 152 of thespine 118 in full extension or hyperextension prosthesis orientations,similarly causing the spine 118 to rotate and seek thelargest-contact-area, lowest-pressure configuration. Advantageously,maintaining such large-area contact between the spine 118 and thefemoral component 12 can lower contact pressures therebetween, therebyminimizing wear and maximizing longevity of the spine 118.

The spine 118 can include a distal portion 118A, an intermediate portion118B and a proximal portion 118C. The distal portion 118A can be fullytapered, such that it engages the tibial stem 138 which can becorrespondingly tapered along its entire length. The tapers of thedistal spine portion 118A and the tibial stem 138 can be conical, anddefine a low-friction interface (such as a polymer-metal interface) toallow the spine 118 to rotate freely within the tibial stem 138. Thetaper of the distal spine portion 118A can be configured to have a taperangle that is slightly less than the taper angle of the tibial stem 138to ensure a clearance fit and improve the mobility of the spine 118. Theproximal portion 118C of the spine 118 can include the anterior surface152 and the posterior cam surface 154, which can be similar to thesurfaces 52, 54 (FIG. 1A), respectively.

An intermediate portion 118B of the spine 118 can have a generallynon-tapered, cylindrical shape configured to pass through the aperture160 formed in the tibial insert 116 with a slight clearance tofacilitate free rotation of the spine 118. The cylindrical, non-taperedprofile of the intermediate portion 118B can be highly resistant toanterior/posterior forces placed upon the spine 118 by a femoralcomponent (such as femoral component 12 FIG. 1A) during articulation ofthe knee. For example, as the spine 118 is urged toward the adjacentinterior wall of the aperture 160 of the tibial insert 116 by a forceFC1 (FIG. 2B), such as by a posterior femoral cam 36 (FIG. 6) duringarticulation of the prosthesis 110 in vivo, the intermediate spineportion 118B can be urged into contact with the tibial insert 116. Whensuch contact occurs, the “vertical” cylindrical wall can arrest anyfurther deflection of the spine 118 by exerting a reaction force FC2, ofthe same magnitude as the force FC1, upon the intermediate portion 118Bof the spine 118. Because the force FC2 is entirely horizontal, nosignificant force urges the spine 118 upwardly (i.e., proximally) ordownwardly (i.e., distally). Thus, the spine 118 can be highlymechanically stable owing to its ability to remain fully seated withinthe tibial stem 138 and the aperture 160, even under heavy loads. Thishighly stable design can be appropriate for use in prostheses where highmechanical stability is beneficial, such as mid-level constraintdesigns, posterior stabilized designs, or any prostheses in which theforces on the proximal portion 118C of the spine 118 are relativelylarge.

Turning now to FIGS. 3A and 3B, another alternative example is shown. Afixed-bearing knee prosthesis 210 can be similar to the prosthesis 110described above, with reference numerals of the prosthesis 210 havingthe same numerals used as the prosthesis 110 except with 100 addedthereto. Structures of the prosthesis 210 correspond to similarstructures denoted by corresponding reference numerals of the prostheses10, 110 except as otherwise noted. The prosthesis 210 can include atibial baseplate 214, a tibial insert 216, and a spine 218 arrangedsimilarly to the prosthesis 110, but the prosthesis 210 is designed toaccept a differently formed spine 218, as described below.

A distal portion 218A of the spine 218 can be similar to the distalportion 118A of the spine 118, in that both are tapered to beaccommodated into the tapered cavity formed in the tibial stem 138, 238,respectively. Similarly, a proximal portion 218C of the spine 218 caninclude surfaces 252, 254 analogous to surfaces 152, 154 of the spine118 (FIGS. 2A and 2B).

However, an intermediate portion 218B of the spine 218 can be slightlytapered as shown in FIGS. 3A and 3B, such that the outer face of theintermediate portion 218B is conical. An aperture 260 is correspondinglyconical, with a similar clearance formed between the aperture 260 andthe intermediate portion 218B. Although tapered, the intermediateportion 218B can define a smaller taper angle as compared to the distalportion 218A.

When a force FC1 is exerted upon the proximal portion 218C of the spine218 (i.e., during flexion of the knee), the spine 218 can slightlydeflect and come into contact with the tibial insert 216. However, owingto the conical shapes of the intermediate spine portion 218B and theaperture 260, the force exerted by the inner wall of the aperture 260 onthe intermediate spine portion 218B can now be separated into ahorizontal reaction force FC3H and a vertical reaction force FC3V (FIG.3B), which is directed upwardly. Concurrently, the horizontal force FC3Htransmitted between the spine 218 and the tibial insert 216 can bereduced as compared to the horizontal force FC1 arising from thenon-tapered intermediate spine portion 118B (FIG. 2B), because some ofthe reaction force is dispersed in the upward direction. This reductionin horizontal force reduces friction between the spine 218 and thetibial insert 216. The spine 218 therefore has an enhanced rotationalfreedom as compared to the spine 118 (FIG. 2B), while maintaining asufficient level of mechanical stability for many applications. Forexample, this stable, yet rotatably free design can be appropriate foruse in prostheses in which a balance between mechanical stability androtational freedom is desired, such as prostheses in which moderateforces are exerted on the proximal portion 218C of the spine 218 duringarticulation.

Turning to FIGS. 4A and 4B, a fixed-bearing prosthesis 310 can include atibial baseplate 314, a cavity 338, a tibial insert 316, and a spine318. The prosthesis 310 can be similar to the prosthesis 210, withreference numerals of the prosthesis 310 having the same numerals usedas the prosthesis 210 except with 100 added thereto. Structures of theprosthesis 310 correspond to similar structures denoted by correspondingreference numerals of prostheses 10, 110, 210 (see FIGS. 1A-3B) exceptas otherwise noted.

A distal spine portion 318A can be tapered in a similar manner to thedistal spine portions 118A, 218A described above. However, theprosthesis 310 can include a “fully tapered” spine 318, in that both thetaper of the distal spine portion 318A carries over into an intermediatespine portion 318B, so that both portions 318A and 318B define one longtapered spine leading up to a proximal spine portion 318C. The proximalportion 318C of the spine 318 can include surfaces 352, 354 analogous tosurfaces 152, 154 of the spine 118 (see FIG. 2B).

The taper angle in the intermediate spine portion 318B can direct someof the forces arising from contact between the intermediate portion 318Band an aperture 360 upwardly, similarly to the less-tapered intermediatespine portion 218B described above. However, the increased taper angleof the intermediate spine portion 318B can direct more force upwardly,thereby further reducing friction between the walls of the aperture 360and the intermediate spine portion 318B. As schematically shown in FIG.4B, the same force FC1 described above can be applied to the proximalspine portion 318C. The reaction forces can be made up of horizontalforce FC4H and vertical force FC4V, similar to FC3H and FC3V describedabove with respect to the partially-tapered spine 218. However, owing tothe greater taper in the intermediate spine portion 318B, FC4H canbecome a smaller constituent of the total reaction force, while FC4V canbecome a larger constituent. Thus, the spine 318 can have a high degreeof rotational freedom and can most readily rotate during flexion of theknee prosthesis 310, because the lower horizontal force FC4H results ina lower friction between the wall of the aperture 360 and theintermediate spine portion 318B. This highly rotationally free designcan be appropriate for use in prostheses where high mechanical stabilityis not required, such as prostheses in which relatively small forces areexerted on the proximal portion 318C of the spine 318 duringarticulation.

Turning now to FIGS. 5A and 5B, a mobile-bearing prosthesis 410 caninclude a tibial baseplate 414, tibial insert 416, and spine 418. Theprosthesis 410 can be similar to the prosthesis 310 in most respects,with reference numerals of the prosthesis 410 having the same numeralsused as the prosthesis 310 except with 100 added thereto. Structures ofthe prosthesis 410 correspond to similar structures denoted bycorresponding reference numerals of prostheses 10, 110, 210, 310 exceptas otherwise noted.

Similar to the tibial insert 16 (see FIG. 1A) described above, thetibial insert 416 of the prosthesis 410 can be rotatable with respect tothe tibial baseplate 414 rather than fixed. The tibial insert 416 candefine a distal surface 462 configured for articulation with a bearingsurface 442 formed on the proximal side of a tibial plateau 440. Theresulting interface 444 can have a low friction coefficient to promotesmooth rotation of the tibial insert 416. An intermediate portion 418Bof the spine 418 can rotatably articulate with an aperture 460 formed inthe insert 416 in a similar manner as described above.

A distal portion 418A of the spine 418 can be similar to the distalportion 118A of the spine 118 (see FIG. 2B), in that both are tapered tobe accommodated into the tapered cavity formed in tibial stems 138, 438,respectively. Similarly, a proximal portion 418C of the spine 418 caninclude anterior and posterior surfaces 452, 454 analogous to surfaces152, 154 of the spine 118 (see FIG. 2B). Although the spine 418 is shownwith a fully-tapered intermediate portion 418B, similar to theintermediate portion 318B of the spine 318, it is contemplated that thenon-tapered spine portion 118B or the slightly-tapered spine portion218B (see FIG. 3B) can also be used with a mobile-bearing prosthesis.

While the above discussion of rotatable spines 118, 218, 318, 418 hasbeen in the context of fixed-bearing or rotatable-bearing prosthesisdesigns, it is contemplated that these same mobile-spine principles canbe applied to mobile bearing designs in which the tibial insert is bothrotatable and translatable with respect to the tibial baseplate.Translation of the tibial insert can be accomplished by having anaperture that allows anterior/posterior movement, lateral/medialmovement or some combination of both directions of movement.

Referring now to FIGS. 6, 7, and 8, a knee prosthesis 10 can include atibial baseplate 14, a tibial insert 16, and a spine 18. The kneeprosthesis 10 can be similar to the prosthesis 10 described above withreference to FIGS. 1A and 1B. Structures of the prosthesis 10, asdescribed with reference to FIGS. 6, 7, and 8 correspond to similarstructures denoted by corresponding reference numerals of the prosthesis10, as described with reference to FIGS. 1A and 1B, except as otherwisenoted.

Referring to FIG. 6, the knee prosthesis 10 is shown in a full extensionposition of the knee joint. The spine 18 is located in the cavity 48 ofthe tibial baseplate 14. The spine 18 passes through the tibial insert16 and occupies the intercondylar fossa 32 anterior to the posteriorfemoral cam 36. The posterior femoral cam 36 can be configured to be incontact with the posterior cam surface 54 at all times during jointmovement or during portions of joint movement. As noted above, when theposterior femoral cam 36 applies force to the spine 18, the spine canrotate. In an example, an anterior cam 34 can extend from the femoralcomponent 12. The anterior cam 34 can engage the anterior surface 52.The anterior cam 34 can prevent hyperextension of the knee joint andalso can cause the spine 18 to rotate.

FIG. 7 illustrates a knee prosthesis 10 as the knee has started to flexand is shown at approximately a 45° flexion. F1 indicates a direction ofmovement of the femoral component 12. The posterior femoral cam 36 canengage the spine 18 at the posterior cam surface 54. The posterior camsurface 54 can be shaped to control relative movement between theposterior femoral cam 36 and the spine 18 and also the shape of theposterior cam surface 54 can influence the rotation of the spine 18 inthe cavity 48.

FIG. 8 illustrates a knee prosthesis 10 as the knee has continued toflex and is shown at approximately a 90° flexion. F2 indicates adirection of movement of the femoral component 12. The posterior femoralcam 36 can engage the spine 18 at the posterior cam surface 54. Theposterior femoral cam 36 can slide along the posterior cam surface 54and is shown at a more distal position than the posterior femoral cam 36of FIG. 7.

The above Detailed Description includes references to the accompanyingdrawings, which form a part of the Detailed Description. The drawingsshow, by way of illustration, specific examples in which the inventioncan be practiced. These examples are also referred to herein as“examples.” Such examples can include elements in addition to thoseshown or described. However, the present inventors also contemplateexamples in which only those elements shown or described are provided.Moreover, the present inventors also contemplate examples using anycombination or permutation of those elements shown or described (or oneor more aspects thereof), either with respect to a particular example(or one or more aspects thereof), or with respect to other examples (orone or more aspects thereof) shown or described herein.

In this document, the terms “a” or “an” are used, as is common in patentdocuments, to include one or more than one, independent of any otherinstances or usages of “at least one” or “one or more.” In thisdocument, the term “or” is used to refer to a nonexclusive or, such that“A or B” includes “A but not B,” “B but not A,” and “A and B,” unlessotherwise indicated. In this document, the terms “including” and “inwhich” are used as the plain-English equivalents of the respective terms“comprising” and “wherein.” Also, in the following claims, the terms“including” and “comprising” are open-ended, that is, a system, device,article, composition, formulation, or process that includes elements inaddition to those listed after such a term in a claim are still deemedto fall within the scope of that claim. Moreover, in the followingclaims, the terms “first,” “second,” and “third,” etc. are used merelyas labels, and are not intended to impose numerical requirements ontheir objects.

The above description is intended to be illustrative, and notrestrictive. For example, the above-described examples (or one or moreaspects thereof) may be used in combination with each other. Otherexamples can be used, such as by one of ordinary skill in the art uponreviewing the above description. The Abstract is provided to comply with37 C.F.R. §1.72(b), to allow the reader to quickly ascertain the natureof the technical disclosure. It is submitted with the understanding thatit will not be used to interpret or limit the scope or meaning of theclaims. Also, in the above Detailed Description, various features may begrouped together to streamline the disclosure. This should not beinterpreted as intending that an unclaimed disclosed feature isessential to any claim. Rather, inventive subject matter may lie in lessthan all features of a particular disclosed example. Thus, the followingclaims are hereby incorporated into the Detailed Description as examplesor examples, with each claim standing on its own as a separate example,and it is contemplated that such examples can be combined with eachother in various combinations or permutations. The scope of theinvention should be determined with reference to the appended claims,along with the full scope of equivalents to which such claims areentitled.

What is claimed is:
 1. A knee joint prosthesis, comprising: a tibialbaseplate including a tibial plateau, having a proximal surface and anopposing distal surface, and a tibial stem extending from the distalsurface of the tibial plateau; a tibial insert, located on the proximalsurface of the tibial plateau, including an aperture; a spine formed ofa first material extending through the aperture of the tibial insert andinto a cavity of the tibial stem, from the proximal surface of thetibial plateau, the spine rotatable with respect to the tibial baseplateand the tibial insert, wherein the spine includes a proximal spineportion, projecting proximally from a proximal articular surface of thetibial insert, wherein the spine includes an intermediate spine portion,the intermediate spine portion disposed within the aperture of thetibial insert, the intermediate spine portion extending from theproximal surface of the tibial baseplate to the proximal articularsurface of the tibial insert, the intermediate spine portion having acylindrical shape, configured to rotatably articulate with a wall of theaperture, wherein the spine includes a distal spine portion, disposedwithin the cavity of the tibial stem, having a tapered, substantiallyconical shape; and a sleeve formed of a second material coupled about anouter spine surface,wherein the first material is different from thesecond material.
 2. The knee joint prosthesis of claim 1, wherein theproximal spine portion has at least one cam surface configured toarticulate with a posterior femoral cam.
 3. The knee joint prosthesis ofclaim 1, wherein the tibial insert includes a sleeve coupled to asurface of the aperture.
 4. The knee joint prosthesis claim 1, whereinthe tibial stem includes a sleeve coupled to a surface of the cavity. 5.The knee joint prosthesis of claim 1, wherein the tibial insert ismobile relative to the tibial baseplate.
 6. The knee joint prosthesis ofclaim 1, wherein the tibial insert is fixed relative to the tibialbaseplate.
 7. The knee joint prosthesis claim 1, wherein the aperture ofthe tibial insert includes cylindrical walls.
 8. The knee jointprosthesis of claim 1, wherein the first material is a polymer.
 9. Theknee joint prosthesis of claim 1, wherein the first material is a metal.10. The knee joint prosthesis claim 1, wherein the second material is apolymer.
 11. The knee joint prosthesis of claim 1, wherein the secondmaterial is a metal.
 12. The knee joint prosthesis of claim 1, whereinthe proximal spine portion is configured to rotate to a lower pressureconfiguration when contacted by a femoral component.
 13. A knee jointprosthesis, comprising: a femoral component including a lateral condyle,a medial condyle, and an intercondylar fossa disposed between thelateral and medial condyles; an articular surface including respectivesurfaces of the lateral and medial condyles; a bone-contacting surface,opposite the articular surface, configured to affix the femoralcomponent to a distal portion of a femur; an anterior cam, disposedanteriorly of the intercondylar fossa, extending from the bonecontacting surface; a posterior cam disposed posteriorly of the anteriorcam; a tibial spine formed of a first material configured to engage theposterior cam during movement of a knee joint, wherein the spineincludes a proximal spine portion, projecting proximally from a proximalarticular surface of a tibial insert, having at least one cam surfaceconfigured to articulate with the posterior femoral cam, wherein thespine includes an intermediate spine portion, the intermediate spineportion disposed within the aperture of the tibial insert, theintermediate spine portion extending from the proximal surface of thetibial baseplate to the proximal articular surface of the tibial insert,the intermediate spine portion having a cylindrical shape, configured torotatably articulate with a wall of the aperture, wherein the spineincludes a distal spine portion, disposed within a cavity of a tibialstem, having a tapered, substantially conical shape; and a sleeve formedof a second material coupled about an outer spine surface, wherein thefirst material is different from the second material.
 14. The knee jointprosthesis of claim 13, wherein the anterior cam is configured to engagethe tibial spine during movement of a knee joint.
 15. The knee jointprosthesis of claim 13, wherein the aperture of the tibial insertincludes cylindrical walls.
 16. A knee joint prosthesis, comprising: atibial baseplate including a tibial plateau, having a proximal surfaceand an opposing distal surface, and a tibial stem extending from thedistal surface of the tibial plateau; a tibial insert, located on theproximal surface of the tibial plateau, including an aperture and aproximal articular surface; a spine formed of a first material extendingthrough the aperture of the tibial insert and into a cavity of thetibial stem, the spine rotatable with respect to the tibial baseplateand the tibial insert, wherein the spine includes a proximal spineportion, projecting proximally from a proximal articular surface of thetibial insert, wherein the spine includes an intermediate spine portion,the intermediate spine portion disposed within the aperture of thetibial insert, the intermediate spine portion extending from theproximal surface of the tibial baseplate to the proximal articularsurface of the tibial insert, the intermediate spine portion having acylindrical shape, configured to rotatably articulate with a wall of theaperture, wherein the spine includes a distal spine portion, disposedwithin the cavity of the tibial stem, having a tapered, substantiallyconical shape; a sleeve formed of a second material coupled about anouter spine surface, wherein the first material is different from thesecond material; and a femoral component, engageable with the tibialinsert, including an articular surface, configured to abut the proximalarticular surface of the tibial insert, and a posterior cam, configuredto engage the spine.
 17. The knee joint prosthesis of claim 16, whereinthe proximal spine portion has at least one cam surface configured toarticulate with the posterior cam.
 18. The knee joint prosthesis ofclaim 16, wherein the femoral component further includes an anterior camdisposed anteriorly of the posterior cam.
 19. The knee joint prosthesisof claim 16, wherein the proximal spine portion configured to rotate toa lower pressure configuration when contacted by a femoral component.20. The knee joint prosthesis of claim 16, wherein the aperture of thetibial insert includes cylindrical walls.